Introduction: Diabetes mellitus is a chronic condition that characterized by raised plasma glucose levels. Diabetes, results from the body’s inability, to produce or use insulin properly, resulting in high levels of blood sugar. There is a derangement in the Carbohydrate, Protein & Fat Metabolism, causing multiple Acute and Chronic complications.
• Wider health problems accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol
levels, obesity, high blood pressure, and lack of regular exercise. Acute complications. Diabetic ketoacidosis
• Diabetic ketoacidosis (DKA) is an acute and dangerous complication that is always a medical emergency and
requires prompt medical attention. Low insulin levels cause the liver to turn fatty add to ketone for fuel (i.e.,
ketosis); ketone bodies are intermediate substrates in that metabolic sequence. This is normal when periodic, but
can become a serious problem if sustained. Elevated levels of ketone bodies in the blood decrease the blood’s al,
leading to DKA. Prompt, proper treatment usually results in full recovery, though death can result from
inadequate or delayed treatment, or from complications (e.g., brain edema). Ketoacidosis is mudt more conunon in
type 1 diabetes than type 2.
• Hyperglycemia hyperosmolar state: • A person with very high (usually considered to be above 300 mg/dl (16 nunoWL)) blood glucose
levels, water is osmotically drawn out of cells into the blood and the kidneys eventually begin to dmnp glucose into the urine. This results in loss of water and an increase in blood osmolarity. If fluid is not replaced (by mouth or intravenously), the osmotic effect of high glucose levels, combined with the loss of water, will eventually lead to dehydration. The body’s cells become progressively dehydrated as water is taken from them and excreted. Electrolyte imbalances are also conunon and are always dangerous. • Hypoglycemia: • Hypoglycemia, or abnormally low blood glucose, is an acute complication of several diabetes treatments. It is rare otherwise, either in diabetic or non-diabetic patients. The patient may become agitated, sweaty, weak, and have many symptoms of sympathetic activation of the autonomic nervous system resulting in feelings akin to dread and immobilized panic. Consciousness can be altered or even lost in extreme cases, leading to coma, seizures, or even brain damage and death • Diabetic coma: • Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of the acute complications of diabetes: • Severe diabetic hypoglycemia • Diabetic ketoacidosis advanced enough to result in tutconsciountess from a combination of severe hyperglycemia, dehydration and shock, and exhaustion • Hyperosmolar nonketotic coma in which extreme hyperglycemia and dehydration alone are sufficient to cause unconsciousness.
• Chronic complications: • Mechanisms of chronic complications: chronic elevation of blood glucose level leads to damage of blood vessels (angiopathv). The endothelial cells lining the blood vessels take in more glucose than normal, since they do not depend on insulin. They then form more siuface glvcoproteins than normal, and cause the basement membrane to grow thicker and weaker. In diabetes, the resulting problems are grouped muter “microvascular disease” (due to damage to small blood vessels) and ttmacrovascular disease” (due to damage to the arteries). However, some research challenges the theory of hyperglycemia as the cause of diabetic complications. The fact that 40% of diabetics who carefully control their blood sugar nevertheless develop new opatlw,119-1 requires explanation. It has been discovered that the sermn of diabetics with new opathy is toxic to nerves even if its blood sugar content is normal.1-1-1-1 Recent researdi suggests that in type 1 diabetics, the continuing autoinumme disease which initially destroyed the beta cells of the pancreas may also cause retinopatlw neu•opathy,U11 and neph•opathy. Examples of chronic complications  The damage to small blood vessels leads to a microangiopathy, which can cause one or more of the following: Diabetic cardiontin kr, damage to the heart muscle, leading to impaired relaxation and filling of the heart with blood (diastolic dysfunction) and eventually heart failure; this condition can occi• independent of damage done to the blood vessels over time from high levels of blood glucose.L1€1
• Diabetic neohropadtv, damage to the kidney which can lead to chronic renal failure, eventually requiring dialysis. Diabetes mellitus is the most comnon cause of adult kidney failure in the developed world. • Diabetic ateuropathy, abnormal and decreased sensation, usually in a ‘glove and stocking’ distribution starting with the feet but potentially in other nerves, later often fingers and hands. When combined with damaged blood vessels this can lead to diabetic foot (see below). Other forms of diabetic nett•opathy may present as mononemitis or autonomic neuropathy. Diabetic amyot•ophy is muscle weakness due to ne•opathy. • Diabetic retittopathy, growth of friable and poor-quality new blood vessels in the retina as well as macular edema (swelling of the macula), which can lead to severe vision loss or blindness. Retinal damage (from microangiopathy) makes it the most common cause of blindness among non-elderly adults in the US. • Diabetic encephalopatItyl21 is the increased cognitive decline and risk of dementia, including (but not limited to) the Alzheimer’s type, observed in diabetes. Various mechanisms are proposed, including alterations to the vascular supply of the brain and the interaction of insulin with the brain itself.fliffal • Macrovascular disease leads to cardiovascular disease, to which accelerated atherosclerosis is a contributor: • Coronary artery disease, leading to angina or myocardial infarction (“heart attack”) • Diabetic myonecrosis (‘muscle wasting’) • Peripheral vascular disease, which contributes to intermittent claudication (exertion-related leg and foot pain) as well as diabetic footfall • Stroke (mainly the iscitemic type)